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CC BY 4.0 · Arq Neuropsiquiatr 2023; 81(08): 756-763
DOI: 10.1055/s-0043-1769123
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COVID-19 in the nervous system: physiopathology and neurological manifestations

Covid-19 no sistema nervoso: fisiopatologia e manifestações neurológicas
Valder Cavalcante Maia Mendonça Filho 
1   Universidade Federal do Ceará, Faculdade de Medicina de Sobral, Sobral CE, Brazil.
,
Amanda Gomes de Oliveira 
1   Universidade Federal do Ceará, Faculdade de Medicina de Sobral, Sobral CE, Brazil.
,
Isabelle de Fátima Vieira Camelo Maia 
2   Universidade Federal do Ceará, Faculdade de Farmácia, Odontologia e Enfermagem, Fortaleza CE, Brazil.
,
Ananda Carolina Moraes de Falcone 
3   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo SP, Brazil.
,
Beatriz Gioppo Betini 
4   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, Ribeirão Preto SP, Brazil.
,
Lucas Bruno Rezende 
5   Universidade Federal de Minas Gerais, Hospital das Clínicas, Belo Horizonte MG, Brazil.
,
Fernando Henrique Magri Alves 
3   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo SP, Brazil.
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Abstract

Background Coronavirus disease 2019 (COVID-19) is a viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although respiratory manifestations have received greater visibility during the pandemic caused by this virus, numerous neurological complaints related to coronavirus 2 infection have been documented in several countries. These records suggest that this pathogen presents neurotropism, and it can cause different neurological conditions of varying intensity.

Objective To investigate the ability of coronavirus 2 to invade the central nervous system (CNS) and its neurological clinical outcomes.

Methods The present study consists in a comprehensive literature review of the records available in the PubMed, SciELO, and Google Scholar databases. The descriptors COVID-19, brain and physiopathology, associated with the Boolean operator AND, were used in the search. Regarding the inclusion and exclusion criteria, we selected the papers published since 2020 with the highest number of citations.

Results We selected 41 articles, most of them in English. The main clinical manifestation associated with COVID-19 patients was headache, but cases of anosmia, hyposmia, Guillain-Barré syndrome, and encephalopathies were also described with considerable frequency.

Conclusion Coronavirus-2 presents neurotropism, and it can reach the CNS by hematogenous dissemination and by direct infection of the nerve endings. It causes brain injuries through several mechanisms, such as cytokine storm, microglial activation, and an increase in thrombotic factors.

Resumo

Antecedentes A doença do coronavírus 2019 (coronavirus disease 2019, Covid-19, em inglês) é uma infecção viral provocada pelo coronavírus 2 da síndrome respiratória aguda grave (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2, em inglês). Embora as manifestações respiratórias tenham recebido maior visibilidade ao longo da pandemia provocada por esse vírus, inúmeras queixas neurológicas relacionadas à infecção pelo coronavírus 2 foram documentadas em diversos países. Tais registros sugerem que esse patógeno apresenta neurotropismo, e é capaz de provocar quadros neurológicos diversos e de intensidade variáveis.

Objetivo Investigar a capacidade de invasão do sistema nervoso central (SNC) pelo coronavírus 2 e seus principais desfechos clínicos neurológicos.

Métodos O presente estudo consiste em uma ampla revisão de literatura a partir dos registros das bases de dados PubMed, SciELO e Google Acadêmico. Nesse contexto, os descritores COVID-19, cérebro e fisiopatologia, associados com o operador booleano AND, foram utilizados na busca. Quanto aos critérios de inclusão e exclusão, selecionou-se os trabalhos publicados a partir de 2020 com o maior número de citações.

Resultados Foram selecionados 41 artigos, a maioria na língua inglesa. A principal manifestação clínica associada a pacientes acometidos pela COVID-19 foi a cefaleia, mas casos de anosmia, hiposmia, síndrome de Guillain-Barré e encefalopatias também foram descritos com frequência considerável.

Conclusão O coronavírus 2 apresenta neurotropismo, e é capaz de alcançar o SNC por disseminação hematogênica e por infecção direta das terminações nervosas. Ele provoca injúria cerebral por meio de variados mecanismos, como tempestade de citocinas, ativação da micróglia e aumento dos fatores trombóticos.

Keywords

COVID-19 - Neurological Manifestations - Viral Tropism - Cytokine Release Syndrome

Palavras-chave

Covid-19 - Manifestações Neurológicas - Tropismo Viral - Síndrome da Liberação de Citocina

Authors' Contributions

VCMMF (main author): conceptualization, data curation, formal analysis, investigation, methodology, project administration, writing of the original draft, and writing – review and editing; AGO: conceptualization, formal analysis, project administration, and writing – review and editing; IFVCM: data curation, project administration, and visualization; ACMF, BGB, LBZ: resources, validation; and FHMA: conceptualization, data curation, project administration, supervision, validation, visualization, and writing of the original draft.




Publication History

Received: 29 August 2022

Accepted: 24 January 2023

Article published online:
04 July 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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